Heading down Franklin Avenue yesterday, I noticed that uncleared snow isn't just a problem for cyclists in the bike lanes (Franklin had nicely bikeable snow-free edges).

Parking is another matter, as the new fixtures for locking bikes disappear under the snow in the zone between sidewalk and street.

*****

Here's the perfect stocking stuffer for the active woman. It's the GoGirl female urinary device. We just gave one to friend heading off for a bike tour through India, but it's also for more mundane locales, including ice fishing, walks in the woods or music festival port-a-johns.

*****

I ran across this news report about a UC Davis study that looked at health complications related to consumption of high fructose corn syrup. If you relied on the London Times article, you'd think:

Scientists have proved for the first time that a cheap form of sugar
used in thousands of food products and soft drinks can damage human
metabolism and is fuelling the obesity crisis.

Beware of statements that limited studies have "proved" anything. Beware also of stories that don't link to the actual research. And beware especially of unfamiliar news sources, especially those owned by Rupert Murdoch.

So I tried to locate the study, and guess what? The news story is riddled with all kinds of errors and misstatements. Bottom line, the biggest problem is we Americans consume too much sugar.

In an interview with The Connecticut Post, he said he had been
refining his views on health care for many years and was “very focused
on a group post-50, or maybe more like post-55” whose members should be
able to buy Medicare if they lacked insurance.

This week, when
there actually seemed to be a compromise on health care that did not
focus on Mr. Lieberman, he announced that he would block the package if
the Democrats included a terrible idea — allowing people between 55 and
65 to buy Medicare.

Here's another study to make conservatives crazy, but progressives should be wary of pushing the findings too far.

In an analysis of previously conducted research on inequality and health studies, epidemiologists have found support for the ideas that income inequality affects health and that there is a threshold of income inequality beyond which adverse impacts on health begin to emerge. They found that individuals “living in regions with high
income inequality have an excess risk for premature mortality
independent of their socioeconomic status, age, and sex.”

In other words, inequality may affect everyone in a society, not just the poor. It may be that income gaps create psychosocial stresses — beyond the obvious nutritional and material differences — that diminish the health of all. The researchers say their findings "need to be interpreted with caution."

In the medical journal BMJ, an editorial by the authors of The Spirit Level: Why More Equal Societies Almost Always Do Better says "the controversial question is not whether more equal societies really do have better health, but why they do" and whether inequality itself is a reason some places are healthier than others.

A society in which all citizens feel free to look each other in the eye
can only come into being once those in the lower echelons feel more
valued than at present. The authors argue that removal of economic
impediments to feeling valued – such as low wages, low benefits and low
public spending on education, for instance – will allow a flourishing
of human potential.

One more thing I'm sure the free market should be able to clear up for us.

"In AARP's skewed view of the world, medicines are always looked at as
a cost and never seen as a savings -- even though medicines often
reduce unnecessary hospitalization, help avoid costly medical
procedures, and increase productivity through better prevention and
management of chronic diseases."

This "medicines as a savings" argument justifying higher prices seems new. And it also seems all-purpose. For example:

Defense spending is always looked at as
a cost and never seen as a savings -- even though new weapon systems often
reduce unnecessary deployment of troops, help avoid costly homeland defense and ground attacks on civilians, and increase productivity through better utilization of ground troops.

Or maybe:

Buying food is always looked at as
a cost and never seen as a savings -- even though packaged food
products often
reduce unnecessary hunting and gathering, help avoid costly rickets, scurvy and starvation, and increase productivity through shorter gutting, skinning and cooking times.

Another spokester at Merck echoed that "Price adjustments for our products have no connection to health care
reform."

Of course not! We know drug companies must raise prices to maintain
profits so they can invest in research and development of new drugs as patents on old ones expire. But that is an ongoing, structural issue that you'd think the industry might have solved by now.

It appears they have, but plead poverty anyway.

Merck raised its
prices about 8.9 percent in the last year, and in 2008 reported profits
of 32.7%, up from 13.5% in 2007. Merck did spend about 20% of sales in
R&D that year, but remember, profit is left after spending on
operations.

The other top three U.S. drug companies reported 2008 profits ranking from 16.5% to 20.3% and R&D spending from 10% to 15% of revenues. In 2007 these companies were more profitable than the largest banks and in 2008, more profitable than the largest oil companies.

What — besides the fact that a very profitable industry agreed to make some price
concessions in the new health care bill — would really account for the need to
jack up prices when almost every other industry is lowering them?

Nidal Hassan, the US Army psychiatrist who is the sole suspect in the Ft. Hood shootings, is 39 years old and graduated with a bachelor's degree in 1997, when he was 27 years old.

It's not unheard of for older graduates to enter medical school after a career change, but Nidal had just finished his undergrad. What was he doing before that?

No one I can find seems to have asked.

And here's a related point. Psychiatry as a specialty is becoming increasingly devalued. Maybe it has always attracted more than its share of impaired personalities, but with the shambles of the mental health treatment system and lousy reimbursement for treatment, the psychiatry is having trouble attracting the best and the brightest.

According to one soon-to-retire shrink, the residency programs are starting to be filled by foreign students with dodgy academic backgrounds. Add to that the social roots and cultural specificity that may have to come into play for successful treatment, and you can see we are heading for a bigger problem than one possibly psychotic guy slipping through his program.

Over the weekend, I spoke with a former diplomat and World Bank type who had lived in Toronto for 20 years. He was lamenting how American ignorance of other cultures and countries made us so susceptible to anecdote-based lies — in this case, about the Canadian national health care system.

I didn't take notes on that conversation, but this post (h/t Hal Davis) from a Canadian centrist built very nicely on the theme (emphasis mine).

It pains me to see my American cousins being denied affordable and
effective health care. It pains me even more the reasons it is being
denied is a series of grand deceits.

Many conservatives proudly introduce themselves as "fiscal
conservatives" as if to imply they have a monopoly on money matters. If
they are politically inclined their "expertise" extends to public
expenditures. It is mainly conservatives who are telling Americans they
cannot afford universal single payer Medicare when the reverse is true
America cannot afford to not implement such a program. Many governments
learned long ago that the only cost effective way to deliver certain
services, specifically Medicare, to the public was through universal
programs where the cost was spread over the entire population; in other
words a collectivity-or that dreaded word that strikes fear in to the
heart of every American-socialism.

This writer has the benefit of our national Medicare plan, a group
benefit plan through my employer, and government run universal car
insurance. These services become affordable or much more affordable
only because a very large number of people make it so by pooling
resources. A so-called fiscal conservative who denies the cost benefits
and efficiencies of this sort of collectivity denies an immutable truth
and one that is ageless.

The idea the private sector provides goods and services more
efficiently than government is only one of the big lies of our times-
and another of the sins of the revenge conservatives has been to
denigrate the role of government to facilitate their greed.

How could our friend, a physician himself, not have known he was dying?

He was wrapped up in the day-to-day struggle to stay upright, to move
air in and out, to swallow something resembling nutrition. This was a
new experience for him, but his medical team had seen it before.

Usually I refer to my wife of 34 years, somewhat archly and awkwardly, as my domestic partner. That started as an act of solidarity with couples who don't have the same rights we have. Plus, the partnership predates the marriage by three years.

Also, since she is a part-time practicing gynecologist and I am a part-time practicing bomb thrower, I've kept her out of this blog except as an occasional wise but shadowy presence.

This week, we've been writing about the same subject from different perspectives, and hers ran in the Strib today, so I'm letting her out of the blog closet a bit here. She also writes a blog, when she isn't too busy with real stuff, about women's health research, called Watching Women's Health.

UPDATE: I chose not to name my friend when I wrote this, because his passing was so fresh, and I expected the people who knew him would immediately recognize Dr. Lowell "Hap" Lutter.

Over the last two days, I watched cancer take down a long-time friend of mine, just as quickly and surely as a cheetah running down a gazelle.

Two weeks ago, we left his house, marveling that he was sick at all, and last night, I sang the last song he ever heard.

He was a doctor and a husband and a father and a sculptor and a fly fisherman. Each year he took his family to Tunisia where he performed free surgeries and had his children learn French. If you were a runner with an injury in the last quarter of the century, his was the name on everyone's lips — the man you had to see, because he understood the runner's obsessions as well as the mechanics. But he especially applied his knowledge to healing children and little people who suffered foot and ankle problems from birth. Runners, despite his prowess and prominence in the sport, were merely a sideline.

He was a modern man and husband, with a life partner who had her own distinguished life, and they raised three great kids who turned out different and well.

He never spoke ill of anyone — in my hearing, at least — and no one spoke ill of him. Although Paul Wellstone, who once consulted him over running injuries when he was still just a professor, seemed awfully disappointed that no miracle had been performed on his behalf.

Irony of ironies, the Twin Cities Marathon ran past his house this morning, making it difficult to reach the front door.

You will read his obituary in a few days, and I guarantee that it will come up short.

As a physician with an assertive spouse, he had likely received more attention than all but Saudi sultans. The cancer had been around for about four years, and it had been beaten
back with radiation and chemicals, visualized into a corner, and monitored through all its feints by some of the best medical people in the state. But he had also languished in hospital wards, bumped around emergency rooms, battled with pharmacies, waited hours for an IV pole to arrive and made fruitless return trips to appointments and paperwork.

Despite this we thought that, in anything approaching a moral universe, he would get another 10 or 15 years.

And as the final hours stole upon him, it became apparent he and his family had not received an important aspect of care from the health care system.

We may have the world's best physicians and medical technology, but nothing is equal to the task of preventing impending death. It comes. It always comes.

There comes a time to set aside
the talk of cell counts and the scan reports and the probabilities, and to talk about the end
and how you want it to be.

And yet, it seems none of the physicians assumed this task — perhaps because it fell in the cracks between specialties, but even more likely because they did not know the details to be managed at the end.

So no one said clearly: You are about to die, and here are the steps you
and your family should take now, while your faculties are sharp and time is not rushing at you. This is how to arrange for hospice. This is what happens if you die at home on a weekend. These are the conversations you and your family will want to have. Then you can spend your last time together the way you desire.

You could call this a death panel, I suppose, but I would call it the final act of care.

After Jesus heals the blind Bartimaeus and others, the JesusCare Call Center administers the claims:

"Well, give me a second while I look that up...ahhh, OK, I
understand what happened. You see, I did perform the eye treatment, but
your policy requires you to be referred by your Primary Care Physician
for any specialist treatment and pre-approved by someone here at
Customer Care before we can be liable for any costs of care, and the
computer says that you didn't do any of that first...so, I apologize,
but we won't be able to make any adjustments to this account."